Santelli, J.S., Edelstein, Z.R., Mathur, S., et al. Journal of Acquired Immune Deficiency Syndromes (March 2013), E-publication ahead of print.
The authors conducted a prospective longitudinal study to assess demographic, behavioral, and biological factors associated with HIV incidence among 6,722 HIV-negative sexually experienced youth (ages 15-24) from 1999 to 2008 in southwestern Uganda. While behavioral and biological factors influenced HIV risk, social transitions such as leaving school and having been married were associated with high HIV risk, suggesting that increasing school attendance and addressing the high-risk group(s) of those formerly married are important HIV prevention initiatives. A total of 207 HIV infections occurred among youth. Young women were at a higher risk for HIV compared with young men. Gender-related risk was greatest among 15- to 19-year-old women; HIV incidence was 14.6 versus 3.5 per 1,000 person-years relative to young men. Multivariate analyses suggested that having multiple partners had the strongest link to increased HIV risk. Young women who lived in a trading village were also at a significantly increased risk. Young men were more likely to drink alcohol, which increased HIV risk, suggesting the need to address substance use in HIV prevention efforts. The authors found that youth were realistic about their HIV risk and were willing to disclose sensitive information about sexual behavior. These findings, they said, indicate opportunities to improve HIV prevention efforts for youth in Uganda and other resource-limited contexts.